Which antihistamine is most likely to be effective in the treatment of pruritic lesions—loratadine (Claritin), fexofenadine (Allegra), fexofenadine with pseudoephedrine (Allegra D), or cyproheptadine (Periactin)?
—Tara Davis, RN, Virginia Beach, Va.

Nonsedating antihistamines, including loratadine and fexofenadine, are not usually helpful for pruritic lesions, except when there is urticaria. Cyproheptadine, an H1 antagonist that causes sedation, certainly has a role in the treatment of pruritus and in pruritic disorders, such as atopic dermatitis. For adults, the usual initial dose is 4 mg (one tablet) three times daily.
—Jeffrey M. Weinberg, MD (118-14)